In 1978 this male patient was affected by tuberculosis of the knee joint. He had undergone 60 streptomycin injections and get relief from pain. But in 2004 again he was suffering from knee pain, crackling on walking and also had a pain in left ankle and foot pain. Until now he was taking BP tablets from 1999. First his right knee was affected then it shifted to his left knee.
Treatment history—
From 2004—2011-he was taking diclofenac daily. If he didn’t take it, he developed severe pain and fever and he couldn’t do his job.
Physical generals—
Appetite-normal
Thirst—1 lit/day
Motion—morning unsatisfactory
Sleep—reduced from 4 years, waking frequently
Position—lying on right side – hand below head
Sweating—normal
Urine—uncontrollable—from 1 year, urging to urinate.
Climate—summer—sweating—irritating—tiredness
Aversion
Cold water, cold food causes cold attack only in summer time.
Bathing—cold water bathing
Covering– uncovering all season.
Food and drinks—
Desire—fish 2+, potato.
Bitter food 2+
Spices
Aversion—sweets
Disagree- potato
Face-warts
Mind—
I felt upset when my wife died; it is the major incident that affected me.
From last four years I had no deep sleep. I don’t have a care, proper food. If she is alive she cares me and nourishes me with proper food, but now I alone have to prepare for myself. I miss my conversation with her. I feel forsaken. I don’t have help now and I am alone. I feel depressed when I am alone. I don’t have a care, consolation and nourishment.
Nature-
I love Tamil literature; I have created stories, verses.
I want the things to be in the proper places
I love silence
I want to do a work quickly; I don’t want to postpone my work and it should be done as soon as possible.
I am always sincere in my work. I am always responsible in my work. My work should be done perfectly, genuinely, accurately.
I love appreciation; I want to be appreciated in my work.
If someone did not give respect and insulted me, I don’t want to see his face even throughout life period. E.g.—one day I went to the barber shop. I was first to sit in the shop, but the barber called another person to get a haircut. I felt insulted, he didn’t give a respect. Thereafter I never go to his shop till now, even though he was my close friend. I want to be respected.
His relative cheated him about property, so from that issue he hates his relative and doesn’t want to see his face.
My analysis—-Traditional approach—
Rubrics—
MIND – AILMENTS FROM – mortification
MIND – CONSCIENTIOUS about trifles
MIND – FASTIDIOUS
MIND – FORSAKEN feeling
MIND – HATRED – persons – offended him; hatred of persons who
MIND – VERSES, makes
MIND – OBSTINATE, headstrong
MIND – DUTY – too much sense of duty
RECTUM – CONSTIPATION – ineffectual urging and straining
BLADDER – URGING to urinate
EXTREMITIES – PAIN – right then left
SLEEP – POSITION – side; on
SLEEP – WAKING – frequent
GENERALS – FOOD and DRINKS – bitter food – desire
GENERALS – FOOD and DRINKS – cold drink, cold water – agg.
GENERALS – FOOD and DRINKS – cold drink, cold water – agg. – hot weather, in
GENERALS – FOOD and DRINKS – fish – desire
GENERALS – FOOD and DRINKS – potatoes – aversion
GENERALS – FOOD and DRINKS – spices – desire
GENERALS – FOOD and DRINKS – sweets – aversion
Above I am fitting the symptoms mechanically into rubrics.
I want to note the peculiar symptoms in the repertorial chart.
GENERALS – FOOD and DRINKS – cold drink, cold water – agg. – hot weather, in
I consider this peculiar symptom as an eliminative symptom. He was affected by a cold attack only in a summer climate, when he consumed cold food and drinks.
The remedies are:
1.bry
2. kali carb
3. nat carb
4. veratrum alb
Bry— agg. MOTION, amel. REST. Materialistic. Possession oriented. Thoughts, talks about BUSINESS. Great THIRST for large quantities (often or long intervals) Dryness
Kali carb—-Systematic, proper, routine-oriented. work, duty,family-oriented. Starting easily. Fears: being alone. Company desires, agg. 2-4 A.M. STITCHING pains, agg. DRAFT
Kingdom approach-–
Periodic table–
4 th row—safety, security, protection, task, job,
1st column—-dependent like a child, incapable, incapacity
I don’t have the capacity to protect myself. I am dependent.
Natrum carb—
Forsaken feeling, Diligent, Verses making, Potatoes – desires
Cold drinks < hot weather
Jan scholten —Carb——diginity, worker, self worth.
Natrum—theme––Sensitive -Alone, depression -HATRED – persons – offended him who. Mortification, Bitter food, fish—desire -Sun intolerance.
Kingdom approach—Periodic table—–
3rd row, 1st column
3rd row—-forsaken, Alone, Care/uncared, Nurturing
1st column—- dependent like a child, incapable, incapacity
Natrum carb–I don’t have the capacity to find my own nourishment and care. Loneliness. No one to care
Veratrum album—-Haughty, rudeness. Dictatorial. Wants social position. Love cold refreshing drinks, Collapse, Maniacal
Natrum carb fit in material medica, rubrics, Jan Scholten method and kingdom approach of Rajan Sankaran, so my choice is 100% sure.
24/3/11
Bp—140/110
Rx – Narum carb 200/1d
31/3/11
Knee pain increased, foot, knee swelling increased, continues fever—99.9f, come to the clinic with cane and help of other. Unable to stand. All the complaints are extremely aggravated.
Sleeps—well
Urine—uncontrollable—mildly changed
Stool-normal, satisfactory.
Rx SL
10/4/11
Pain, swelling reduced, fever on and off. sleep-normal.urine—able to control.
Rx SL
24/4/11
Fever completely stooped. Pain, swelling better. Generals—good
Rx SL
8/5/11
BP—140/90
Generals—good
Knee pain, swelling, 70% better
Advised to take ice cream and cold drinks, because in May whenever he took cold drinks,ice cream, it immediately leads to cold attack, cough and running nose which continued up to 20 days .
Rx SL
30/5/11
No cold attack even after he drank cold, ate water ice cream in May.
Able to sit on Indian toilet, whereas before he could not sit on Indian toilet. Pain, swelling—considerably better.
Rx SL
12/6/11
Sleep—better compared to before, but waking 3 am and can’t sleep— from last 3 days.
Knee pain-mildly increased, swelling –mild.
Mind—feels alone, helpless.—last 3 days.
Rx
I want to repeat the drug, but I fear to give the dry dose, because of aggravation, so I decided to give split potency.
Nat carb 200/1pill/15ml water + 30 drop alcohol—stock solution
Advised to give 2 drops (from stock solution) in 100 ml water—take only 1 spoon from the tumbler, whenever the pain is greater.
28/6/11
1 spoon taken, One time (split dose)
Pain , swelling increased again, but tolerable.
Generals—good sleep
Rx SL
13/711
Pain, swelling. Good sleep. Generals—good
Rx SL
28/7/11
Pain, swelling—75%better
Sleep-good. Mind—better compares to before—alone feeling reduced.
Rx SL
11/8/111
One spoon of dose taken—due to pain. Knee pain, swelling—better, sleep—good, no frequent waking, urine—controllable –60% better
Rx SL
23/8/11
Knee-70% better. Able to flex
Sleep—waking –3 am, but after waking can fall back to sleep. Generals—good
Rx SL
7/9/11
One time water dose taken. Pain , swelling—75% better. Able to ascend the stairs without pain.
Rx SL
28/9/11
Bp—140/90
Mild pain only on continuous walking, but tolerable.
Generals—good
Rx SL
15/10/11
Bp = 148/100
One time water dose taken.
Sleep-good.
Pain-better but on and off after heavy work.
Rx SL
20/11/11
140/100
Two water doses taken as per my advice by phone
Mild heart burn
Pain better
Urine—urgency-mild
Rx SL
30/12/11
Sleep—feels alone; whenever thinking about this I don’t have sleep.
Pain, swelling –improved
Rx
Advised to take 1 spoon from 1st tumbler (1st tumbler contains 100 ml water mixed with 2 drops of medicine from stock solution)—twice a week.
20/1/12
Heartburn –better
Pain-reduced at same level. Swelling completely gone
Rx SL
9/2/12
Generals—good. pain at same level.
Mind—alone feeling—there, but reduced
Rx
Advised to take 1 spoon from 1st tumbler (1st tumbler contains 100 ml water mixed with 2 drops of medicine from stock solution)—weekly 2 times
29/3/12
Crackling sound on walking
Pain improved at same level
Sleep—good
BP—126/90
Rx SL
22/4/12
Mild elbow joint pain—10 days
Sleep-good
Mind—well
Rx SL
18/5/12
BP-130/80
One time water dose taken
Elbow pain gone
Sleep, mind—well
25/6/12
BP-130/90
Knee pain –4 days
Ankle pain—2 days
Generals—good
Rx : advised to take one time water dose
12/7/12
Knee, ankle pain—better
Generals—good
Rx SL
28/7/12
BP-122/90
Pain—reduced—85%
Crackling of knee-mild
Generals—good
Mind –considerably changed, forsaken feeling gone
Rx SL
Advised to stop the BP tablet.
13/8/12
BP—130/80
Knee pain,flexing,swelling—all complaints considerably better
Mental well being is good
Generals—good
Rx SL
17/9/12
BP—130/80
Physically, mentally—good
Rx SL
8/10/12
Last 19 months he is able to do his work without help of others.
He is still working; pain and swelling are considerably improved
BP—tablet— stopped completely
Physical and mental well being is good
Rx SL
Very good case analysis and case management skills. The reasons
for preferring 3rd row Nat-c to 4th row Kali-c are not mentioned.
However it is clear that Nat-c acted as the true smm in this case.
Congrats.
Dr V T Yekkirala